Professionals Eligible to Participate But For Whom the

20.1.3 – Professionals Eligible to Participate But For Whom the Payment Adjustment Does Not Apply (Rev. 10, Issued: 07-27-12, Effective: 10-29-12, Implementation: 10-29-12) The payment adjustment does not apply to an eligible professional if any of the following apply: • Based on primary taxonomy code in the National Plan and Provider Enumeration System (NPPES),the eligible professional is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of – o June 30, 2011 for the 2012 payment adjustment, o June 30, 2012 for the 2013 payment adjustment, or o June 30, 2013 for the 2014 payment adjustment. • The eligible professional does not have prescribing privileges and reports G-code G8644 (defined as not having prescribing privileges) at least one time on a Medicare Part B claim prior to – o June 30, 2011 for the 2012 payment adjustment, o June 30, 2012 for the 2013 payment adjustment, and/or o June 30, 2013 for the 2014 payment adjustment. • The eligible professional does not have at least 100 cases containing an encounter code in the eRx measure’s denominator for dates of service between – o January 1, 2011 and June 30, 2011 for the 2012 payment adjustment, 6 o January 1, 2012 and June 30, 2012 for the 2013 payment adjustment, and/or o January 1, 2013 and June 30, 2013 for the 2014 payment adjustment.